Bouchra FakhirMarrakech. Cadi Ayyad University, Marrakech, Morocco
Title: Conservative management of 23 cases of acreta in university hospital Mohamed the VI in Marrakesh, Morocco
Placenta accreta is no longer a rare condition in obstetrics; its incidence has been increasing in recent years. It is a placental insertion abnormality that consists of abnormal adherence of the placenta to the myometrium and carries a high risk of hemorrhage during delivery. In addition, it requires an antenatal diagnosis in order to decrease the risk of maternal and neonatal morbidity as well as mortality.
Patient and Methods:
Our work is a retrospective study conducted over a period of 07 years from January 01, 2012 to December 31, 2018, concerns cases of placenta accreta collected at the Mohammed VI University Hospital in Marrakech, within the Department of Obstetrics and Gynecology. The objective of our work is to report the experience of the service with a study of the epidemiological, diagnosis, therapeutic and prognosis profile of the cases of placenta accreta treated in this department.
The mean age of our patients was 34.7 years [23-42 years], the frequency was estimated at about 2.17/10000 deliveries (0.02%), the risk factors were represented by a scarred uterus in 89% of our patients (only one primiparous), curettage in 4 (22.22%) of our patients and placenta previa in 88.89% of cases. The clinical manifestations were third trimester metrorrhagia in seven (39%) patients, 2 (11%) were in labor and one was admitted for threatened preterm delivery. The remaining cases were asymptomatic. The antenatal diagnosis of placenta accreta consisted of MRI-confirmed ultrasonography in 7 cases and ultrasonography alone in 3 cases, with indicator signs including interruption of the hypoechoic uteroplacental surface, presence of intraplacental lacunae, and turbulent flow in the Doppler gap, among others. The histology study showed 1 placenta accreta and 1 placenta increta in the 2 cases where the pathology result was mentioned. The mean gestational age was 37.7SA. Conservative treatment was successful in 10 cases (55.56%) compared with 8 (44.44%) who underwent hysterectomy; 3 cases underwent hysterectomy immediately and 5 cases underwent hysterectomy after failure of conservative Placenta accreta à propos de 23 cas au sein du service gynéco-obstétrique du CHU Mohammed VI de Marrakech 79 treatment. However, both types of treatment were not without complications, mainly infectious for conservative treatment and haemorrhagic for radical treatment, and only one case of death by DIC in a context of pre-eclampsia after hysterectomy.
Placenta accreta is no longer a rare condition. Antenatal screening is intended for high-risk patients. Conservative treatment preserving subsequent fertility would be preferred to radical treatment given the associated morbidity and mortality except in rare cases due to the increased risk of hemorrhage.